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Cited by 7Youth Substance Use and School AttendanceSubstance Abuse Treatment and OutcomesHomelessness and Social Issues

Reaching hidden youth in Singapore through the Hidden Youth Intervention Program: A biopsychosocial approach integrating mental health and social work interventions

Open access
Khiatani, Sonia, Liu, Denise, Yeo, Benjamin Sen Son, Wong, John Chee Meng·2023·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2023.1133659PMC PMC10061831
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Abstract

Hidden youth are youth who withdraw from society for at least 6 months, physically isolating within their homes or rooms. There has been a steady rise in this phenomenon across many developed countries, and this trend is expected to continue. As hidden youths often present with complex psychopathology and psychosocial issues, multi-factorial intervention approaches are recommended. To reach this isolated population and address gaps in services, a community mental health service and a youth social work team collaborated to develop the first specialized intervention for hidden youth in Singapore. This pilot intervention combines components from Hikikomori treatment models from Japan and Hong Kong, and a treatment program for isolated individuals diagnosed with Internet Gaming Disorder. This paper describes the development of the pilot intervention model- a four-stage biopsychosocial intervention targeting the complex needs of hidden youth and their families- and illustrates its implementation and challenges faced through a case study. Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are also highlighted. Preliminary outcomes of this ongoing pilot intervention indicate reductions in social withdrawal behavior and increased engagement in school or work, especially for youth at the final stage of intervention. Strengths of the program include its multi-disciplinary and flexible nature, and the whole-family approach. Limitations of this program included a lack of information on Singaporean hidden youth and the lack of quantitative outcome data of this pilot program. In future, we aim to further enhance program elements through collaboration with international and local partners, and to develop an evaluative framework to determine program effectiveness.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper describes the development and first two years of Singapore’s Hidden Youth Intervention Program (HYIP), a four-stage biopsychosocial, multidisciplinary program for hidden youth aged 12–25 and their caregivers. Preliminary service data from 25 youths suggest reductions in social withdrawal severity and increased school/work engagement, especially at Stage 4, but the pilot lacks quantitative outcome data.

Key findings

  • HYIP served 25 youth and their families since 2021; at intake, mean age was 15.58 years (SD = 1.65), mean age of onset of social withdrawal was 13.52 years (SD = 1.45), and mean delay from onset to intake was 2.06 years (SD = 1.32), shorter than Japan’s 4.4 years; 64% were male and 72% were from middle-class families.
  • Overall, 56% of youth showed reductions in severity between intake and latest contact; by stage, 1 out of 5 youth (20%) at Stage 1 showed reductions versus 5 out of 6 youth (83%) at Stage 4.
  • Overall, 40% were engaged in school or work, rising to 83% at Stage 4; 24% overall participated in community/interest-based, vocational, or animal-assisted activities, rising to 50% at Stage 4.
  • The program is intensive: all cases averaged 10.80 months (SD = 5.14) and 17.88 sessions (SD = 15.00); Stage 4 cases averaged 14.11 months (SD = 5.75) and 26.00 sessions (SD = 13.80), with only 2 cases closed so far.

Methods

  • Design: descriptive pilot/program-development paper with a case study (Adam) illustrating the four-stage model; administrative data were compiled for 25 youths served since 2021.
  • Data and analysis: demographic information, case characteristics, and social workers’ assessments were analyzed descriptively and reported only in aggregates such as means and standard deviations. In October 2021, three reflective practice circles involving 14 social workers were conducted; deidentified transcripts were coded using the six-step thematic analysis process in NVivo 11.
  • Sample: hidden youth aged 12–25 and their caregivers; youth were assessed as hidden youth if they had isolated at home (not leaving more than three times a week) for 6 months or more with significant functional impairment, and were categorized as mild, moderate, or severe.

Limitations

  • Stated: HYIP was based on intervention models from Japan, Korea, and Hong Kong because research on hidden youth in Singapore is in its infancy; the lack of local prevalence, trends, and characteristics meant the program could not account for these factors in its design.
  • Stated: the pilot lacks quantitative outcome data, success and good practices are measured qualitatively through case studies, and future work needs standardized outcome measurement; most youths could not complete self-report questionnaires at Stage 1, and no English caregiver-report measure of hidden youth behavior was available.
  • Evident from the text: outcomes are preliminary and uncontrolled, only 2 cases have been closed, and community engagement is limited to attendance of programs and activities conducted within the organization.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2023.1133659

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 25 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Anxious caregivers who express helplessness with their child's behavior and avoid confronting or disciplining their child can perpetuate their child's social withdrawal.

    “For example, anxious caregivers who express helplessness with their child's behavior and avoid confronting or disciplining their child can perpetuate their child's social withdrawal (35).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] Hareven, 2020, The scope and nature of prolonged social withdrawal in Israel: an initial quantitative and qualitative investigation, Int J Soc Psychiatry. source
  • Premisecitation

    Family interventions to improve parent-child relationships, family psychotherapy, and parent support groups have been identified as essential components of hidden youth interventions.

    “In line with FST, family interventions to improve parent-child relationships (11), family psychotherapy (18), and parent support groups (22), have been identified as essential components of hidden youth interventions.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [11] Kato, 2019, Hikikomori: multidimensional understanding, assessment, and future international perspectives, Psychiatry Clin Neurosci. source

      The Family support section says family interventions are crucial for people with hikikomori who live with family and describes an educational support program for parents. It does not identify parent support groups specifically as an essential intervention; that is the part attached to this citation. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [18] Teo, 2010, Japanese culture-bound syndrome of social withdrawal? A proposal for DSM-V, J Nerv Ment Dis. source

      Citation (18) is attached to family psychotherapy. The Case Report (page unavailable) describes a withdrawn boy whose parents attended regular family therapy, but it does not identify family psychotherapy as an essential component of hidden-youth interventions generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [22] Chan, 2014, Hidden youth services: what Hong Kong can learn from Japan, Child Youth Serv Rev. source
  • Premisecitation

    The type of intervention should take into account the youth's level of social isolation.

    “According to previous studies, the type of intervention should take into account the youth's level of social isolation (11).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [11] Kato, 2019, Hikikomori: multidimensional understanding, assessment, and future international perspectives, Psychiatry Clin Neurosci. source
  • Premisecitation

    Home visits conducted by trained professionals are an effective method to engage the youth and family.

    “Home visits conducted by trained professionals (24) are an effective method to engage the youth and family.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Lee, 2013, Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea, Psychiatry Clin Neurosci. source
  • Premisecitation

    Through interest-based activities, youths can also learn vocational skills that enhance their sense of competency and self-esteem, which are vital to reintegration.

    “Through interest-based activities, youths can also learn vocational skills that enhance their sense of competency and self-esteem, which are vital to reintegration (14).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Ranieri, 2018, Hikikomori: debating a XXI century phenomenon from a clinical point of view, Scand J Child Adolesc Psychiatr Psychol. source

      In “Treatment of acute social withdrawal in adolescence” (page unavailable), the case describes a girl who enjoyed caring for her dogs and began going out to walk them, then to meet friends. This supports a limited connection between a personal interest and renewed social contact. The paper does not say that interest-based activities taught vocational skills or improved competency and self-esteem. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 23
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Biopsycho integrative approaches have been used in hidden youth interventions in Japan and Korea, and the psychosocial approach has been used in Hong Kong.

    “Biopsycho integrative approaches have been used in hidden youth interventions in Japan (3) and Korea (24), and the psychosocial approach has been used in Hong Kong (28).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [3] Kato, 2018, Hikikomori: experience in Japan and international relevance, World Psychiatry. source
    • cites [24] Lee, 2013, Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea, Psychiatry Clin Neurosci. source

      For the Korea citation, the Home visitation program section (page unavailable) describes a home-based intervention with interviews of socially withdrawn youth and their parents and planned person-centered psychotherapy. That supports the use of an intervention in Korea, but the paper does not describe its program as a biopsychological integrative approach or report a biological treatment component. The Japan and Hong Kong portions are attached to other citations and are not judged here. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [28] Wong, 2019, Efficacy of a multicomponent intervention with animal-assisted therapy for socially withdrawn youth in Hong Kong, Soc Anim. source

  • May combine two claims.

    Premisecitation

    PIPATIC has been effective in reducing addiction and ensuring reintegration into the community in patients diagnosed with internet gaming disorder.

    “PIPATIC has been effective in reducing addiction and ensuring reintegration into the community in patients diagnosed with internet gaming disorder (31, 32).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [31] Torres-Rodríguez, 2018, Treatment efficacy of a specialized psychotherapy program for Internet Gaming Disorder, J Behav Addict. source

      The Discussion reports reduced IGD symptoms and improved social abilities and family relationships in the PIPATIC group. It describes reintegration into normal life as a program aim, but does not establish that treatment ensured reintegration into the community. The supplied passages have section labels but no page numbers. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [32] Torres-Rodríguez, 2019, Internet gaming disorder treatment: a case study evaluation of four different types of adolescent problematic gamers, Int J Ment Health Addic. source

      The Results (page unavailable) report that IGD scores improved in four treated adolescents and remained stable three months later; school, social-problem, and family-conflict scores also improved. These findings support reduced gaming-disorder symptoms, but they do not establish that PIPATIC ensured reintegration into the community, or demonstrate effectiveness beyond the four cases studied. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given

    Good practices include recognizing caregivers as the experts of their child's life, working with caregivers to co-develop engagement strategies based on caregivers' understanding of their child, and obtaining regular feedback about the child's progress.

    “Good practices include recognizing caregivers as the experts of their child's life, working with caregivers to co-develop engagement strategies based on caregivers' understanding of their child, and obtaining regular feedback about the child's progress.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are highlighted.

    “Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are also highlighted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The caregiver support group allows caregivers to connect with each other and share their difficulties and successes.

    “This group allows caregivers to connect with each other and share their difficulties and successes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Caregivers often feel helpless, angry, or ashamed when their child remains socially withdrawn despite their best efforts.

    “Caregivers often feel helpless, angry, or ashamed when their child remains socially withdrawn despite their best efforts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Informing caregivers upfront about the approach to intervention reduced the likelihood that caregivers would pressure the youth to meet the social worker in subsequent stages and empowered caregivers to manage expectations of external parties.

    “Informing the caregivers upfront about the approach to intervention, including the expected duration required to engage youths (up to 12 months), the overall timeline of the intervention, the frequency of home visits, and the need to respect the boundaries set by the youth reduced the likelihood that caregivers would pressure the youth to meet the social worker in subsequent stages of intervention”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Social workers face challenges remaining attuned to the youth's comfort level and pacing sessions accordingly, and motivating youth to engage with others.

    “Social workers face challenges remaining attuned to the youth's comfort level and pacing sessions accordingly, and motivating youth to engage with others.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    As HYIP is still ongoing, only 2 cases have been closed so far.

    “As HYIP is still ongoing, only 2 cases have been closed so far.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Ensuring that services are coordinated is challenging for the social worker who usually serves as the overall case manager.

    “ensuring that services are coordinated is challenging for the social worker who usually serves as the overall case manager.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    HYIP professionals faced difficulties managing their anxiety over the lack of progress in attaining intervention goals and felt frustrated when hidden youth regressed to an earlier stage of intervention after making initial progress.

    “HYIP professionals faced difficulties managing their anxiety over the lack of progress in attaining intervention goals and felt frustrated when hidden youth regressed to an earlier stage of intervention after making initial progress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On average, cases at the reintegration stage have been open for 14.11 months, with an average of 26 sessions conducted by social workers.

    “On average, cases at the reintegration stage have been open for 14.11 months, with an average of 26 sessions conducted by social workers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Intervention does not occur in a linear manner; youths may regress when setbacks or challenges arise.

    “intervention does not occur in a linear manner- youths may regress when setbacks or challenges arise.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Adam's experience is representative enough to illustrate the 4-step intervention model and the non-linear nature of intervention.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Families are often confused about the role of each professional in the intervention plan.

    “Families are often confused about the role of each professional in the intervention plan.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    64% of youth served by HYIP were male.

    “64% were male”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Others are concerned that family members would overhear their conversations.

    “Others are concerned that family members would overhear their conversations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Some youths are not comfortable with the social worker entering their rooms, which they view as their safe space.

    “For instance, some youths are not comfortable with the social worker entering their rooms, which they view as their safe space.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At intake, youth were on average 15.58 (SD = 1.65) years old.

    “At intake, youth were on average 15.58 (SD = 1.65) years old.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    Persistent and patient "one-way" engagement initiated by the social worker enable youth to be in control of the interaction and respond only when they feel comfortable doing so.

    “Persistent and patient “one-way” engagement initiated by the social worker enable youth to be in control of the interaction and respond only when they feel comfortable doing so by, for example, responding to letters.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Job-training, vocational skills and reengagement with education are components of effective hidden youth interventions and build the youth's academic and vocational competence.

    “Job-training (22), vocational skills and reengagement with education (39), which are components of effective hidden youth interventions, also build the youth's academic and vocational competence.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Chan, 2014, Hidden youth services: what Hong Kong can learn from Japan, Child Youth Serv Rev. source
    • cites [39] Wong, 2020, Social withdrawal as invisible youth disengagement, Int J Sociol Soc Policy. source

  • May combine two claims.

    Premisecitation

    Animal Assisted Therapy has been effectively incorporated into intervention models and has qualitatively been shown to be effective.

    “Animal Assisted Therapy has also effectively been incorporated into intervention models, and has qualitatively been shown to be effective (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2017, Regional Technical Report

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    These emotions often affect their interactions with their child, possibly reinforcing their child's social withdrawal.

    “These emotions often affect their interactions with their child, possibly reinforcing their child's social withdrawal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This studies involving human participants were reviewed and approved by Fei Yue Community Services Research Advisory Committee.

    “This studies involving human participants were reviewed and approved by Fei Yue Community Services Research Advisory Committee.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written informed consent to participate in the program and its evaluation was provided by the participants' legal guardian/next of kin.

    “Written informed consent to participate in the program and its evaluation was provided by the participants' legal guardian/next of kin.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study was reviewed by Fei Yue Ethics Advisory Committee and determined that administrative data and deidentified transcripts constituted secondary data.

    “The Fei Yue Ethics Advisory Committee reviewed this study (refer to Ethics Statement) and determined that administrative data and deidentified transcripts constituted secondary data collected for the purposes of program improvement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Much of the success of engagement reported is dependent on a high level of clinical resource vested, professional commitment, responsive and contextualized clinical creativity, peer supervision, and tenacity of the outreach professionals.

    “much of the success of engagement reported is dependent on a high level of clinical resource vested, professional commitment, responsive and contextualized clinical creativity, peer supervision, and tenacity of the outreach professionals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The measure of community engagement is limited to youth's attendance of programs and activities conducted within the organization.

    “Our measure of community engagement is limited to youth's attendance of programs and activities conducted within our organization”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The program's high resource investment helps to mitigate staff burnout and attrition risk.

    “the program's high resource investment helps to mitigate staff burnout and attrition risk”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The program provides youths and their families with integrated biopsychosocial services involving a multidisciplinary team, reducing the potential for dropout and overlap between multiple services.

    “By addressing hidden youth behavior as a multi-faceted phenomenon, the program provides youths and their families with integrated biopsychosocial services involving a multidisciplinary team, reducing the potential for dropout and overlap between multiple services.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Due to the strong focus on achieving high levels of education for all, and compulsory military service for males at age 18, it may be easier to identify socially withdrawn youth in Singapore, creating opportunities for early intervention.

    “Due to the strong focus on achieving high levels of education for all, and compulsory military service for males at age 18, it is may also be easier to identify socially withdrawn youth in Singapore, creating opportunities for early intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The integrative and long-term nature of the program allows for thorough, evolving formulations of each case, as well as highly individualized intervention plans.

    “The integrative and long-term nature of the program also allows for thorough, evolving formulations of each case, as well as highly individualized intervention plans.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Such flexibility allows youths to progress at a comfortable pace.

    “Such flexibility allows youths to progress at a comfortable pace.”
    Quote in the paperNot a substantial claim
32 of 32

  • The paper relies on this without support.

    CBT has established validity in treating comorbidities such as depression and anxiety.

    “The psychological intervention approach used was that of Cognitive Behavioral Therapy (CBT), due to its established validity in treating comorbidities such as depression and anxiety.”

  • The paper relies on this without support.

    There are no studies of hidden youth in Singapore.

    “As there are no studies of hidden youth in Singapore, our understanding is based on models from other countries and case studies seen by professionals in Singapore.”

  • The paper relies on this without support.

    There is a dearth of evidence-based practices for the treatment of hidden youth.

    “Overall, there is a dearth of evidence-based practices for the treatment of hidden youth and there are no programs in Singapore to our knowledge that focus on hidden youths specifically.”

  • The paper relies on this without support.

    There are no programs in Singapore to our knowledge that focus on hidden youths specifically.

    “Overall, there is a dearth of evidence-based practices for the treatment of hidden youth and there are no programs in Singapore to our knowledge that focus on hidden youths specifically.”

  • The paper relies on this without support.

    Hidden youth are typically not enrolled in these services as programs require at least one engagement with the youth before they can be accepted into the service, which youths typically resist.

    “Hidden youth are typically not enrolled in these services as programs require at least one engagement with the youth before they can be accepted into the service, which youths typically resist.”

  • The paper relies on this without support.

    Service eligibility criteria, such as needing to be enrolled in school to access school-based interventions, also limit access to services.

    “Service eligibility criteria, such as needing to be enrolled in school to access school-based interventions, also limit access to services.”

  • The paper relies on this without support.

    Most services are time-limited and lack the continuum of care necessary to provide effective intervention to hidden youth.

    “Lastly, most services are time-limited and lack the continuum of care necessary to provide effective intervention to hidden youth.”

  • The paper relies on this without support.

    School-based programs usually have a maximum duration of 12 months, and cases are closed after repeated unsuccessful attempts to engage the youth.

    “For example, school-based programs usually have a maximum duration of 12 months, and cases are closed after repeated unsuccessful attempts to engage the youth.”

  • The paper relies on this without support.

    Youths view this as ego-syntonic.

    “Youths view this as ego-syntonic.”

  • The paper relies on this without support.

    There is currently no prevalence data available in Singapore.

    “There is currently no prevalence data available in Singapore, however, estimates from Japan (4) and Hong Kong (5) indicate that the prevalence of hikikomori is between 1.2 and 1.9%.”

  • The paper relies on this without support.

    Certain factors unique to Singapore (cultural factors, variation in parenting in a multi-racial society, and national military service conscription for males at age 18) may affect hidden youth pathology and thus intervention.

    “it is known that certain factors unique to Singapore may affect hidden youth pathology and thus intervention. These include cultural factors, variation in parenting in a multi-racial society, and unique national military service conscription for males at age 18, at which time youths are required to leave home for enlistment.”

  • The paper relies on this without support.

    The Japanese data on delay between onset and intake (4.4 years) is comparable to the Singaporean HYIP context.

    “which is relatively shorter compared to data from Japan [4.4 years, (50)]”

  • The paper relies on this without support.

    The typical profile of hidden youth from prior work applies to the Singaporean HYIP population.

    “Youth served by HYIP are similar to the typical profile of hidden youth −64% were male, and 72% were from middle-class families (16).”

  • The paper relies on this without support.

    Adam's experience is representative enough to illustrate the 4-step intervention model and the non-linear nature of intervention.

    “Adam's experience in HYIP is used to illustrate the 4-step intervention model.”
14 of 14

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Stage 1 session SD is incompatible with its range

    Minor

    For five youths with a mean of 8.20 sessions and a range of 3-10, the sample standard deviation cannot reach 6.57; even a loose upper bound from the stated mean and range is about 3.42.

  • Overall session range excludes a Stage 3 value

    Minor

    Table 1 gives 59 as the maximum number of sessions for Stage 3, but only 50 as the maximum across all cases.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Beck, 2005, Beck Youth Inventories Second Edition for Children and Adolescents Manual.
  2. Fei, 2020, Documentation of Practice: The Fei Yue's Model of Street-Based Services.

Cited by

Sorted by citations

Related

Authors
Khiatani, S., Liu, D., Yeo, B. S. S., & Wong, J. C. M.
Affiliations
  • National University Hospital (SG)
  • National University of Singapore (SG)
Corresponding author
Khiatani, Sonia
ORCID
Wong, John Chee Meng
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2023-03-16
Volume
14
Pages
1133659-1133659
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2023.1133659
PMC
PMC10061831
OpenAlex
W4327593721
Cited by
7
References
47
Citations by year
2026: 3 · 2025: 2 · 2024: 2
FWCI
5.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National University Health System
Topics
  • Social Sciences › Education › Youth Substance Use and School Attendance
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
social withdrawal, hikikomori, biopsychosocial intervention, community mental health services, youth social work, internet gaming disorder, family involvement, outreach strategies, caregiver support, Singapore

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